14 HEALTH SERVICES PROVISION

Resilient national health systems are essential for countries to prevent, detect, respond to and recover from public health events, while ensuring the maintenance of health systems functions, including the continued delivery of essential health services (EHS) at all levels. Particularly in emergencies, health services provision for both event-related case management and routine health services are equally as important. Moreover, ensuring minimal disruption in health service utilization before, during and after an emergency – and across the varied contexts within a country – is also a critical aspect of a resilient health system.

IMPACT:

Resilient health systems that are capable of delivering emergency related clinical care, and optimal utilization of health services while ensuring continuity of health systems functions including delivery of essential health services in emergencies.

MONITORING AND EVALUATION:

(1) Evidence of demonstrated application of case management procedures for events caused by IHR relevant hazards. (2) Optimal utilization of health services, including during emergencies. (3) Ensuring continuity of essential health services in emergencies.

Benchmark 14.1

Case management procedures are implemented for relevant IHR hazards

Objective To develop and implement case management procedures for all relevant IHR hazards

01 NO CAPACITY

  1. No case management guidelines are available for priority health events.

02 LIMITED CAPACITY

  1. Develop a list of priority diseases and IHR relevant hazards based on the country risk profile at national and subnational levels.
  2. Establish a scientific advisory board involving senior health experts, including academia, to lead the development of standardized case management guidelines for priority diseases and IHR relevant hazards. *
  3. Develop standardized case management guidelines for priority diseases and IHR relevant hazards.
  4. Develop triggers for sharing and recording information on diseases, conditions and public health emergencies of international concern with relevant multisectoral agencies. *
  5. Develop dissemination plans (including training packages) for case management guidelines for all levels targeting all relevant health workers.
  6. Map health system resources available to manage cases of priority diseases and simultaneously maintain routine essential health services, including a primary health care approach.
  7. Develop a package of health services required for effective, safe, high quality case management in priority health emergencies and adapt to be relevant at all levels of care.
  8. Adapt case management training package to be relevant to the roles of key stakeholders from relevant sectors and disseminate accordingly. *

03 DEVELOPED CAPACITY

  1. Disseminate case management guidelines at the national level and to points of entry, and test implementation. *
  2. Develop and disseminate SOPs for the management and transport of potentially infectious patients, including patient referral, transportation mechanisms and referral centres based on priority risks at the national level. *
  3. Review and adapt the legal framework for quality, safe and secure implementation of case management procedures for relevant IHR hazards at the national and subnational levels. *
  4. Train relevant health workers at the national level, including managers and decision-makers, on case management guidelines (as applicable to the target audience) and update preservice training curricula for health professionals to include current guidelines on case management of priority diseases. *
  5. Prioritize investment in prehospital care facilitates/patient transport mechanisms. *
  6. Conduct multidisciplinary SimEx/AAR/IAR (as relevant) at the national level including review of the effectiveness and efficiency of case management guidelines. *
  7. Develop and maintain an up-to-date roster of health workers trained in case management of priority risks/diseases, based on national and subnational risk profiles.
  8. Provide a list of trained personnel from relevant sectors for the case management roster, including the private sector.

04 DEMONSTRATED CAPACITY

  1. Disseminate case management guidelines and SOPs for the management and transport of potentially infectious patients at the subnational level. *
  2. Review case management, patient referral, transportation mechanisms, management and transportation of potentially infectious patients and document in accordance with guidelines and SOPs based on actual experience or a specific exercise to evaluate these procedures. *
  3. Consider specific requirements for vulnerable groups including children, woman, elderly, forcibly displaced people, etc. are included in case management processes, guidelines and SOPs for relevant IHR hazards. *
  4. Conduct regular multidisciplinary SimEx/AAR/IAR (as relevant) with participation from all levels of health service delivery, and update case management guidelines and SOPs based on recommendations. *

05 SUSTAINABLE CAPACITY

  1. Establish a mechanism to allow for the continuous presence of trained staff and resources for case management, patient referral and transportation for all IHR relevant emergencies/hazards. *
  2. Document and disseminate lessons learned from case management for IHR relevant emergencies. *
  3. Engage the country in country peer-to-peer learning programmes at the subnational, national and international levels. *
  4. Support research programmes to generate evidence on the development and implementation of guidelines and SOPs for case management, patient referral and transportation for management of IHR relevant emergencies, including community perspectives. *
  5. Establish an institutionalized mechanism for M&E of the implementation of recommendations/application of lessons from SimEx/AAR/IAR (as relevant), etc. *
  6. Train local community health workers on case management guidelines and SOPs for management and transport of patients potentially infected with priority diseases.
  7. Include the management of priority diseases/events during health emergencies in relevant sector’s protocols, policies, plans, etc., with identification of necessary resources to support collaboration with the health sector, recognizing the widespread impacts of health emergencies on all sectors and society.

Benchmark 14.2

Mechanism for continuity of essential health services (EHS) during a health emergency is well established

Objective To ensure continuity of EHS during an emergency

01 NO CAPACITY

  1. EHS package is not defined and there are no plans or guidelines for continuity of EHS during emergencies.

02 LIMITED CAPACITY

  1. Review existing emergency preparedness and response plans/health sector plans to identify the level of inclusion of continuity of EHS (including population based services) during emergencies. *
  2. Include continuity of EHS package during emergencies into the national health strategic plan and national emergency preparedness and response plans, with provision to provide EHS package to all, including vulnerable groups and those affected by unintended and inequitable consequences of policy measures such as shutdowns/curfews during emergencies. *
  3. Conduct assessments to identify the risks and capacity at all levels of care including primary care, hospitals and field health services to provide EHS and continuation of EHS during health emergencies. *
  4. Involve health system focal points in developing PHEOC plans/protocols with clear identification of the role of health system focal points in PHEOC actions, IMS, ToRs, etc. to support the continuation of EHS during health emergencies. *
  5. Define or update the EHS package for the country based on population health needs, with consideration to the continuity of services during a health emergency.
  6. Conduct a situation analysis of current preparedness activities for the continuation of EHS during emergencies.
  7. Involve PHEOC focal persons in health service continuity planning and health sector strategic and operational plans to maintain coherence between emergency preparedness and response and health service continuity plans.
  8. Identify and list all relevant multisectoral stakeholders to support continued delivery of EHS during emergencies, such as prehospital care, transport, delivery of medicine, WASH, supply chain and logistics support, housing, social services and education.
  9. Incorporate the continued delivery of EHS during a health emergency into the ToRs of relevant sectors.

03 DEVELOPED CAPACITY

  1. Establish and test a well functioning, safe, effective, quality and equitable EHS delivery, including access to primary care, before, during and after emergencies.
  2. Develop and test mechanism for monitoring EHS continuity before, during and after emergencies, including identification of vulnerable groups who need to be specially considered during specific types of emergencies.
  3. Develop and test mechanisms for the protection of medical staff, effective staff rotation and optimum IPC methodologies to ensure continuity of EHS through maintaining safe staffing levels.
  4. Develop mechanisms to support the continuity of EHS at the health facility level during an emergency, such as effective triage and adapted access to primary health care services.
  5. Train health workers and decision-makers, on their roles to maintain EHS during emergencies and mechanisms developed to support EHS continuity.
  6. List critical health service operations/functions that need to be continued during health emergencies in the health ministry and all relevant related departments at the national and subnational levels.
  7. Map private and nongovernment institutions that can be mobilized during emergencies and agree on roles and responsibilities before, during and after emergencies to ensure continuity of EHS alongside emergency service provision. *
  8. Conduct a risk assessment in relevant sectors to identify and list critical operations and functions that need to be continued during emergencies to the support delivery of EHS.
  9. Develop continuity planning of essential functions that support the continuity of EHS by relevant sectors including private and nongovernment institutions.

04 DEMONSTRATED CAPACITY

  1. Develop/update an integrated health information system (surveillance, service delivery, service utilization data) with quality data flow and reporting mechanisms from both public and private sector with an allocated budget for decision-making and continuity of EHS. *
  2. Implement mechanism/system to monitor continuity of EHS before, during and after emergencies.
  3. Monitor health services data, considering the risk for disruptions during emergency response operations, in coordination with other emergency related data including readiness and response. *
  4. Use data on service delivery continuity to inform decision-making on EHS and optimum emergency response care during emergencies.
  5. Routinely monitor the availability of health service continuity plans at subnational and health facility levels.
  6. Conduct SimEx/AAR/IAR (as relevant) at national and subnational levels to test the functionality of EHS continuation plans/guidelines during emergencies. *
  7. Allocate contingency funds that are accessible at subnational and health facility levels for addressing challenges related to continuing EHS during emergencies. *
  8. Develop and finalize prearrangements and MoUs to facilitate EHS continuity during emergency responses, such as relocation of offices, additional transport and accommodation, internet connectivity solutions during an emergency and provision for rapid recruitment of staff at the national and subnational levels during an emergency, including private and nongovernment sectors. *
  9. Maintain regular communication and coordination mechanisms/platforms between sectors to ensure continuity of EHS before, during and after emergencies.
  10. Support from relevant sectors to the health ministry before, during and after emergencies as outlined in prearrangements and MoUs.

05 SUSTAINABLE CAPACITY

  1. Update and test plans regularly based on the recommendations from SimEx/AAR/IAR and all relevant M&E processes. *
  2. Identify and conduct health system research on the continuation of EHS during emergencies. *
  3. Share the best practices of EHS during emergencies among subnational, national and international forums. *
  4. Institutionalize/mainstream joint working between emergency, humanitarian response, health system, disease, primary health care, life course specific and other vertical programmes at policy, planning and operational levels for EHS continuity. *
  5. Allocate sufficient resources to the health ministry and all relevant departments for effective maintenance and restoration of critical functions and services to continue EHS at acceptable predefined levels following an emergency. *
  6. Update other sector’s roles in maintaining EHS during emergencies as part of sector specific protocols, plans, policies, training etc.

Benchmark 14.3

Mechanism is in place to ensure effective utilization of health services before, during and after health emergencies at all levels of health service delivery

Objective To ensure effective utilization of health services before, during and after emergencies at all levels of health service delivery

01 NO CAPACITY

  1. Very limited service utilization during and beyond emergencies.

02 LIMITED CAPACITY

  1. Map existing health services facilities required to deliver safe, effective, quality and equitable health services before, during and after emergencies at the national level. *
  2. Conduct a situational analysis of previous or current practices of health service utilization during emergency response, or estimate based on the best available data if no recent health emergency response has occurred. *
  3. Establish a technical working group with relevant stakeholders to develop and/or update a functional mechanism, including SOPs to increase or maintain the utilization of health services before, during and after emergencies. *
  4. Develop standards for effective health service utilization for all levels of health services, both in government and nongovernment sectors including private sector, before, during and after emergencies. *

03 DEVELOPED CAPACITY

  1. Map existing health service facilities required to deliver safe, effective, quality and equitable health services before, during and after emergencies at the subnational level, including nongovernment and private sector health facilities. *
  2. Develop and formalize MoUs with nongovernment health facilities, including private sector, to support health service utilization before, during and after emergencies. *
  3. Disseminate and implement SOPs to increase or maintain the utilization of health services before, during and after emergencies at the national level. *
  4. Disseminate and implement standards for effective health service utilization for health services, both in government and nongovernment sectors including private sector, before, during and after emergencies at the national level. *
  5. Conduct SimEx/AAR/IAR (as relevant) to review/test the SOPs and standards of effective health service utilization at the national level. *
  6. Develop a plan to strengthen health facilities that do not have capacity to provide safe, effective, quality and equitable health services before, during and after health emergencies.
  7. Develop a mechanism and capacity to conduct health service utilization data analysis and interpretation before, during and after emergencies.
  8. Support from relevant sectors to provide health services before, during and after emergencies, as appropriate to existing capacities.
  9. Support from relevant sectors to strengthen government health facilities and improve capacity for health service utilisation.

04 DEMONSTRATED CAPACITY

  1. Disseminate and implement SOPs to increase or maintain the utilization of health services before, during and after emergencies at the subnational level, including nongovernment and private health facilities. *
  2. Disseminate and implement standards for effective health service utilization for health services, both in government and nongovernment sectors including private sector, before, during and after emergencies at the subnational level. *
  3. Conduct analysis and disseminate results for health service utilization before, during and after emergencies and notify when there is disruption in health service utilization during emergencies. *
  4. Update mechanisms, SOPs and standards based on the result of M&E, including the results of reviews and SimEx. *
  5. Compile health service utilization data from across all facilities and relevant sectors. *
  6. Allocate resources to implement plans to strengthen selected health facilities to provide safe, effective, quality and equitable health services before, during and after emergencies.
  7. Monitor and evaluate health service utilization data before, during and after emergencies.
  8. Providing resource support from relevant sectors to health sector during major emergencies

05 SUSTAINABLE CAPACITY

  1. Disseminate the updated mechanisms, SOPs and standards to all health facilities. *
  2. Conduct reviews of events (SimEx/AAR/IAR, as relevant) regularly on health service utilization at all levels. *
  3. Share experiences (best practices/lessons learned) and peer-to-peer learning on health service utilization before, during and after emergencies at regional/national and global forums. *
  4. Share or use the results of reviews and analysis of health services utilization to inform the updating or development of national health sector strategic plan.

* Participation and contribution of other sectors to action.

Tools